Aurora St. Luke's Medical Center

Presentation Notes

Poster presented at: Aurora Scientific Day; May 20, 2020; virtual webinar hosted in Milwaukee, WI.


Background: Hospitalized patients with blood stream infections (BSI) are at increased morbidity and mortality risk despite advances in therapy and overall care. Audit and provider feedback for positive blood cultures by pharmacists has been shown to improve care and outcomes for patients with BSI. However, previous studies employed pharmacy specialists with infectious diseases (ID) training in a centralized audit and feedback model. It is unknown if decentralized inpatient pharmacists, with support from ID pharmacists as needed, could impact patient care similarly.

Purpose: To evaluate antibiotic treatment and outcomes for patients with BSI for whom blood culture audit and provider feedback was performed by decentralized inpatient pharmacists.

Methods: This was a retrospective review of 100 adult patients with BSI in Aurora Health Care with a positive blood culture from April 1, 2019, to June 30, 2019. Data collected included patient demographics, blood culture draw time, culture results (gram stain, pathogen, antibiotic susceptibilities), time to empiric antimicrobial therapy start, and time to antibiotic optimization. The primary outcome assessed was time from blood culture draw to effective empiric antimicrobial therapy. The secondary outcome assessed was time from blood culture draw to optimal antimicrobial therapy. Outcomes collected were compared to previously published studies.

Results: 100 patients with positive blood cultures were included. Urine was the predominant BSI source (47%), followed by skin/ soft tissue (14%). The most common pathogens were gramnegative bacilli (61%). A total of 8 multidrug resistant organisms were identified. The median time to effective antibiotic therapy from blood culture draw was 2 hours (interquartile range [IQR]: 1–4.75). The median time to optimal definitive antibiotic therapy was 36 hours (IQR: 2.13–64). These results are similar to previously published studies of ID pharmacy specialists in a centralized audit and feedback model.

Conclusion: Audit of blood stream infections and provider feedback by decentralized inpatient pharmacists, along with as-needed support from infectious disease pharmacists, may represent an alternative to the centralized ID pharmacist model. Application of these findings to practice will allow for more efficient use of pharmacist time and expand decentralized inpatient pharmacy practice.

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